OBJECTIVE--To determine the mortality and health effects from the current civil war in Kabul, Afghanistan. SUBJECTS--One resident population and one displaced population. DESIGN--Between November 22 and December 16, 1993, we conducted a retrospective, population-based, household survey, interviewing 312 displaced families and 300 resident families. RESULTS--During the 285 days before the survey, the highest average daily crude mortality rate and the mortality rate for those younger than 5 years (0.9 and 2.6 per 10,000 population per day, respectively) were among residents who had lived at their current location for 10 months or less. The average daily crude mortality rate and the mortality rate for those younger than 5 years were lower among displaced persons (0.6 and 1.9 per 10,000 per day) and lowest among residents who had lived at their current location for more than 10 months (0.5 and 0.6 per 10,000 per day). Overall, the most common cause of death for both groups was gunshot or other war trauma; for children younger than 5 years, deaths resulting from measles, diarrhea, and acute respiratory tract infection predominated. CONCLUSIONS--While provision of basic public health measures would likely decrease mortality among both displaced and resident populations, the most urgent health need is for a cessation of hostilities against the civilian population. During humanitarian relief operations, organizations should not focus exclusively on persons identified as displaced.

OBJECTIVES: The purpose of this study was to describe the injuries sustained by displaced people returning home after a military conflict when landmines were not removed. METHOD: This study describes the landmine injuries to patients at the Jaffna Teaching Hospital in northern Sri Lanka over a 20-month period, from May 1, 1996, to December 31, 1997. RESULTS: There were definite and identifiable landmine injury patterns. Patients were most often wounded in the lower extremities, had multiple wounds, and were injured together in groups. Victims were most often male, but there were unusually high numbers of women, children, and elderly injured. Mortality rates and amputation rates were high. Deaths occurred early after injury. Higher incidences of mine injuries could be associated with two important activities: returning home and agriculture. CONCLUSIONS: Civilians returning home after armed conflicts are at risk of injury when landmines are not removed. No one is spared. This problem is preventable.

OBJECTIVE: To measure retrospectively mortality among a previously inaccessible population of former UNITA members and their families displaced within Angola, before and after their arrival in resettlement camps after ceasefire of 4 April 2002. DESIGN: Three stage cluster sampling for interviews. Recall period for mortality assessment was from 21 June 2001 to 15-31 August 2002. SETTING: Eleven resettlement camps over four provinces of Angola (Bié, Cuando Cubango, Huila, and Malange) housing 149 000 former UNITA members and their families. PARTICIPANTS: 900 consenting family heads of households, or most senior household members, corresponding to an intended sample size of 4500 individuals. MAIN OUTCOME MEASURES: Crude mortality and proportional mortality, overall and by period (monthly, and before and after arrival in camps). RESULTS: Final sample included 6599 people. The 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 000/day (95% confidence interval 1.3 to 1.8), and, among children under 5 years old, to 4.1/10 000/day (3.3 to 5.2). Monthly crude mortality rose gradually to a peak in March 2002 and remained above emergency thresholds thereafter. Malnutrition was the leading cause of death (34%), followed by fever or malaria (24%) and war or violence (18%). Most war victims and people who had disappeared were women and children. CONCLUSIONS: This population of displaced Angolans experienced global and child mortality greatly in excess of normal levels, both before and after the 2002 ceasefire. Malnutrition deaths reflect the extent of the food crisis affecting this population. Timely humanitarian assistance must be made available to all populations in such conflicts.

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